Clinical Practice Guidelines are evidence-based statements and recommendations designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients.

Clinical guidelines are based on the most current scientific evidence, and are adopted or adapted from standards published by recognized sources. Each guideline is reviewed and updated by Health Plan staff and approved annually by the plans’ Quality Monitoring Committee.

These guidelines are not a statement of benefits. Individual coverage will need to be verified by the Plan.

Adopted from the NYS DOH “Clinical Guideline for the Diagnosis, Evaluation and Management of Adults and Children with Asthma” developed by the New York State Consensus Asthma Guideline Expert Panel and Endorsed by the New York State Department of Health updated July, 2017” and the NHLB National Heart, Lung, and Blood Institute: Guidelines for the Diagnosis and Management of Asthma (EPR-3). Reviewed March 2018 Next review March 2020.

ADHD Guideline
Adopted from the American Academy of Pediatrics: Reviewed March 2018. Next review March 2020.

Assessment and Management to Reduce Cardiovascular Risk
Adopted from the American Heart Association February 2018. Next review February 2020.
The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.

Management Heart Failure
Adopted from the American Heart Association February 2018. Next review February 2020.
The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.

Adopted from the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (AAP/ACOG)Guidelines for Perinatal Care, Eighth Edition. September, 2017 and New York State Department of Health. Reviewed February 2018 Next review October 2019.

Preventive Care of Adults A19ges and Older: Practice Guidelines:
Reviewed March 2018. Next scheduled review March 2019.
Adopted from the U.S. Preventive Services Task Force (USPSTF)Recommendations for Adults

Excellus has adopted the following exceptions to the USPSTF recommendations: